Impact of adenotonsillectomy in pediatric respiratory function / Impacto de la cirugía adenoamigdalar sobre la función respiratoria pediátrica

Introduction: Adenotonsillar hypertrophy (ATH) is an important health condition that leads to upper airway obstruction and constitutes the main cause of obstructive sleep disordered breathing (OSDB) in children. The aim of this study was to analyze the effect of surgical intervention on spirometrical parameters of children with ATH/OSDB and upper airway recurrent infections (URTIs). Material and methods The study covered children treated surgically in a Pediatric Ambulatory Unit in a tertiary hospital. Spirometric tests were performed before and three months after surgery and results were compared. Results A total of 78 children were enrolled with a mean age of 6.95 ± 2,81 years. There was a significant improvement in forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), peak expiratory flow (PEF) and forced expiratory flow rate at 25% (F25) values after surgery in children suffering from OSDB (FVC pre: 1.52 ± 0.47 L vs FVC post: 1.85 ± 0.63 L, p < 0.001; FEV1 pre: 1.24 ± 0.38 L vs FEV1 post: 1.39 ± 0.40 L, p = 0.014; PEF pre: 2.04 ± 0.85 L/s vs PEF post: 2.33 ± 0.76 L/s, p = 0.014; F25 pre: 1.77 ± 0.77 L/s vs F25 post: 2.02 ± 0.73 L/s, p = 0.030). On a multivariate analysis model, preoperative tonsil size and performing tonsillectomy were the most significant determinants of improvement in spirometric values (p < 0.05). Children with isolated adenoid hypertrophy without tonsillar obstruction and those with URTIs alone did not show relevant differences in spirometric values after surgery (p > 0.05). No significant differences were found concerning pre-operative and post-operative forced expiratory flow rate at 75% (F75) and forced expiratory flow between 25 and 75% of the pulmonary volume (FEF25–75%) in any group (p > 0.05). Conclusions Surgery seems effective in ameliorating spirometry values in patients with OSDB and ATH, namely FVC, FEV1, PEF and F25. ... (AU)

Introducción: La hipertrofia adenoamigdalar (HAA) es una importante condición de salud que conduce a la obstrucción de las vías respiratorias superiores y constituye la principal causa de trastornos respiratorios obstructivos del sueño (TROS) en los niños. El objetivo de este estudio fue analizar el efecto de la intervención quirúrgica sobre los parámetros espirométricos de niños con HAA/TROS e infecciones recurrentes de las vías respiratorias superiores (IrVAS). Material y Métodos El estudio abarcó a niños operados en una Unidad Ambulatoria Pediátrica de un hospital de tercer nivel. Se realizaron espirometrías antes y tres meses después de la cirugía y se compararon los resultados. Resultados Se incluyeron un total de 78 niños con una edad media de 6,95 ± 2,81 años. Hubo una mejora significativa en los valores de capacidad vital forzada (FVC), volumen espiratorio forzado en el primer segundo (FEV1), flujo espiratorio máximo (PEF) y tasa de flujo espiratorio forzado al 25 % (F25) después de la cirugía en niños que sufrían de TROS (FVC pre: 1.52 ± 0.47 L vs FVC post: 1.85 ± 0.63 L, p < 0.001; FEV1 pre: 1.24 ± 0.38 L vs FEV1 post: 1.39 ± 0.40 L, p = 0.014; PEF pre: 2.04 ± 0.85 L/s vs PEF post: 2.33 ± 0.76 L/s, p = 0.014; F25 pre: 1.77 ± 0.77 L/s vs F25 post: 2.02 ± 0.73 L/s, p = 0.030). En un modelo de análisis multivariado, el tamaño preoperatorio de las amígdalas y la amigdalectomía fueron los determinantes más significativos de la mejora en los valores espirométricos (p < 0.005). Los niños con hipertrofia adenoidea aislada sin obstrucción amigdalina y aquellos con IrVAS sin TROS no mostraron diferencias relevantes en los valores espirométricos tras la cirugía (p > 0,05). ... (AU)

A Pilot Program: Using Text Messaging to Improve Timely Communication to Tonsillectomy Patients.

Approximately 1,500 tonsillectomies are performed annually at a large pediatric academic medical center each year. Families need to be educated on how to care for their child after this surgery. Most tonsillectomy patients are discharged home either the same day as surgery or after one night of observation, resulting in post-operative tonsillectomy recovery and care falling upon the patient's family. Multiple quality improvement efforts to improve family education post tonsillectomy surgery have been performed over the last several years at a large pediatric academic medical center. None of these efforts, however, have focused on the use of technology to provide innovative patient education. The purpose of this project is to provide information to parents via text messages and videos to improve patient experience and outcomes following tonsillectomy. Families provided positive feedback, including that the texts were helpful, easy to understand, and reduced pre-operative and recovery anxiety. Also, none of these families needed to call the ENT clinic for any other questions or concerns. The recovery from tonsillectomy is not easy and this pediatric otolaryngology practice is always searching for new ways to improve care and education. Use of technology is an innovative approach and likely one that will be used more often in the future.

Parental Analgesic Knowledge and Decision Making for Children With and Without Obstructive Sleep Apnea After Tonsillectomy and Adenoidectomy.

Tonsillectomy is a common and painful procedure often indicated for children with obstructive sleep apnea (OSA) who are at risk for opioid-related toxicity. Whether parents whose children have OSA understand the risks of opioids is unknown. The purpose of this study was to examine whether parents whose children have OSA have greater opioid risk understanding and would be less likely to give an opioid to a child exhibiting oversedation compared to parents whose children do not have OSA. The study design was a secondary analysis of a prospective observational study. The study was conducted in a large academic, tertiary care children's hospital in the Midwest. 224 parents whose children with or without OSA underwent tonsillectomy with/without adenoidectomy were included. Parents were assessed for opioid adverse event understanding and then made decisions to give/withhold opioids for a child exhibiting adverse effects. After discharge, parents recorded all opioid doses they gave their child. There were no differences in opioid understanding between OSA and non-OSA groups, and nearly half in both would give an opioid to the child exhibiting oversedation. Similar amounts of opioids were given at home. OSA did not predict parents' opioid decisions; however, around-the-clock instruction predicted greater opioid use at home. Parents whose children had OSA had a similar understanding of opioid-related oversedation compared to other parents, and half would give a prescribed opioid when signs of oversedation were present, suggesting a need for improved understanding and recognition of this sign of toxicity, and of what to do should this symptom present.

Adenoidectomía bajo control visual con técnica de electrocoagulación-succión: experiencia en el Hospital Universitario San Ignacio / Visually controlled suction-cautery adenoidectomy: a prospective study at San Ignacio University Hospital

La adenoidectomía con técnica de electrocoagulación-succión bajo control visual es un procedimiento cada vez más utilizado para el tratamiento de hipertrofia obstructiva de las adenoides, dada su comprobada efectividad en cuanto a la precisión y extensión completa en la remoción del tejidoadenoideo, su baja complejidad técnica, rapidez y seguridad al minimizar riesgos. En este estudio se evalúan diferentes aspectos de esta técnica tales como: el tiempo quirúrgico del procedimiento, el sangrado transoperatorio y la incidencia de complicaciones en las primeras semanas del postoperatorio. Esta técnica quirúrgica es la que utilizamos en la actualidad en el Servicio deOtorrinolaringología del Hospital Universitario San Ignacio en Bogotá.

Visually controlled suction-cautery adenoidectomy is the most common technique to perform adenoidectomy in developed countries, due to its proven effectiveness in removing enlarged adenoid tissue, its low technical complexity, and decrease in operating time, trans-operative bleeding and higher safety rate. The present prospective study evaluates different outcomes when using this surgical technique, such as duration of the procedure, intra-operative bleeding and incidence of complications. This technique is the one currently used by the authors at San Ignacio University Hospital in Bogota.

Growth and growth biomarker changes after adenotonsillectomy: systematic review and meta-analysis.

OBJECTIVE: To determine the effect of adenoidectomy and/or tonsillectomy ("adenotonsillectomy") upon growth and growth biomarkers, in the context of sleep disordered breathing (SDB). SDB in children, primarily due to adenotonsillar hypertrophy, increases the risk of growth failure. DESIGN: Systematic review and meta-analysis. PubMed, ERIC and Cochrane Reviews databases from January 1980 to November 2007 were searched for studies reporting: pre/post-adenotonsillectomy height and weight changes as percentage increased or decreased, raw data, z scores or centiles, or: IGF-1 and/or IGFBP-3 serum-level changes as z scores or raw data. For anthropometrics, the meta-analysis included studies presenting z scores or centiles. SETTING: Observational studies. PATIENTS: Otherwise healthy children, not selected for obesity. MAIN OUTCOME MEASURES: Pre/post-surgery changes in standardised height and weight, and IGF-1 and IGFBP-3. RESULTS: Of 211 citations identified, 20 met systematic review criteria. SDB was an enrolment criterion in 13 of the studies, and one of several enrolment criteria in three. Meta-analysis findings for pre/post-surgery changes were: standardised height: 10 studies, 363 total children, pooled standardised mean differences (SMD) = 0.34 (95% CI 0.20 to 0.47); standardised weight: 11 studies, 390 total children, pooled SMD = 0.57 (95% CI 0.44 to 0.70); IGF-1: 7 studies, 177 total children, pooled SMD = 0.53 (95% CI 0.33 to 0.73); IGFBP-3: 7 studies, 177 total children, pooled SMD = 0.59 (95% CI 0.34 to 0.83). CONCLUSIONS: Standardised height and weight, and IGF-1 and IGFBP-3 increased significantly after adenotonsillectomy. Findings suggest that primary care providers and specialists consider SDB secondary to adenotonsillar hypertrophy when screening, treating and referring children with growth failure.

Return to home, school, and sports after electrosurgical adenoidectomy: when is it safe?

OBJECTIVE: To determine when it is safe for healthy children to return to home, school, and sports after uncomplicated electrosurgical adenoidectomy (EA). DESIGN: (1) A survey of Canadian otolaryngologists (COs) regarding their EA complication rates and their opinions regarding best practice standards for patient care after EA. (2) Informal retrospective analysis of approximately 200 children who have been allowed to resume sports 3 days after uncomplicated EA. RESULTS: (1) Thirteen COs responded to the survey. The total estimated EA cases performed were 8617 over 10 years. Four patients were known to have bled mildly; none required reoperation. Eleven of 13 COs supported discharge home 2 hours after uncomplicated EA if other standard discharge criteria were met. Seven of 13 COs supported a return to school the next day if the child had returned to his or her usual state of health; however, 2 COs suggested 7 to 10 days at home. Four of 13 COs supported a return to sports 3 days after uncomplicated EA. (2) None of the 200 children who had been allowed to resume sports 3 days after uncomplicated EA have had any known bleeding. At least 10 toddlers have actually engaged in unplanned strenuous exercise within 4 to 6 hours of EA without adverse effect. CONCLUSIONS: Considerable variation exists in Canada in terms of current practice standards regarding return to home, school, and sports after uncomplicated EA. Survey data suggest that, after uncomplicated EA, it is safe for healthy children to return home after 2 hours and to school the next day. Preliminary data suggest that it may be safe for children to resume sports 3 days after uncomplicated EA; however, ideally, this should be studied prospectively, on a large scale.

Hiperplasia adenoamigdaliana y cor pulmonale detectado con ecocardiografía-Doppler / Adenoamygdalian hyperplasy and cor pulmonale detected with echocardiografy-Doppler

Se realiza un estudio prospectivo para detectar elementos de Cor Pulmonale en niños con hiperplasia obstructiva de adenoides y/o amigdalas. Se evaluaron los exámenes disponibles para ello y los resultados después de adenoamigdalectomía. Se evaluaron clínicamente 24 niños (1 año 7 meses-5 años 2 meses) por ORL y Cardiólogo y se les efectuaron ECG, Rx tórax, gases arteriales, Ecocardiografía-Doppler. En 16 pacientes (67%) la Eco-D estuvo alterada (Hipertrofia y/o dilatación de Ventrículo derecho). Todos los ECG fueron normales. Se encontró hipoxemia en 5 niños. Los síntomas clínicos y los cambios Ecocardiográficos fueron revertidos después de la adenoamigdalectomía. La prevalencia de Hipertensión pulmonar en niños con hiperplasia adenoamigdalina aún es subestimada